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View of patients with diabetes (1) One of the things I use a lot is a lancing device. Dont we all? Yes, yes we do, but I dont think many people give them that much thought. http://dontfeardiabetes.com/2010/06/one-touch-delica-my-first-product-review/ (visited June 12, 2010) http://dontfeardiabetes.com/2010/06/one-touch-delica-my-first-product-review/

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View of patients with diabetes (2) Many discussion about this topic in blogs of patients, pros and cons of the different devices Patients are most often not involved in the selection of the lancing device! Selection of the lancet devices handed over to them by chance or simply the one that comes along with the BG meter Replacing a lancet at a time is consuming and laborious

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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Why finger pricking? Intensified insulin therapy requires SMBG in capillary blood samples collected at the finger tips Finger pricking makes the SMBG an annoying procedure (more pain than insulin injection) Major reason (besides the costs) why patients do not to measure their BG frequently Small number of publications about lancets and modern lancing devices (more recently) Again an aspect that is highly relevant for patients that is ignored by academic research Considerable know-how has accumulated inside the respective companies

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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Which size of blood drop do we need? It is not only the size of the blood drop needed for the measurement per se that is relevant Blood drops must be of appropriate size to allow patients to see it and to guide the tip of the test strip to it Blood drop must have a certain size to allow sucking up of the required volume with certainty Reproducible generation of a small blood drop (<1.0 µL) is practically difficult Realistically 2-4 µL are needed

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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Why do we prick finger tips? High blood flow at the finger tips Allows generation of blood drops with the first attempt (= high success rate) Patients hate to prick again!

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? Which lancing devices are the best and why? What is needed? What is the future?

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What do patients do in reality? Survey in Germany: 2000 people with diabetes were randomly chosen to be a representative sample of patients performing SMBG according to age, sex and type of treatment Questionnaire sent out: 20.04. – 05.05.2006 Nearly 1000 people responded Performed by Marktforschungsinstitut Ipsos, Hamburg Sponsor: Roche Diagnostics, Mannheim, Germany Koschinsky T. Blood glucose self-monitoring report 2006 reveals deficits in knowledge and action. Diabetes, Stoffwechsel und Herz 16:185-192, 2007

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10% Total (n = 966) 19% 25% 22% 5% 16% once 2-4 times 5-7 times 8-10 times 11-13 times 14 times and more Nutzungshäufigkeit einer Lanzette What do patients do in reality?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = AST Which lancing devices are the best and why? What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? What is needed? What is the future?

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Lasette, Cell Robotics ISO tech Laser Doctor® Send a laser beam to the skin to burn a little hole into the very upper layers of the skin only, Advantage: - no stimulation of pain receptors Disadvantages: - devices is bulky and expensive - side effects: a certain bang, a little cloud of smoke, some smell and not generating a sufficient amount of blood each time

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? = electronic approach What is needed? What is the future?

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Perfect control of needle movement/depth of insertion Advantages: - no pain! - new approach / new ideas Disadvantages: - Company is not active anymore - devices was expensive ($200) - no publications Same happened with the Renew Lancing system (not electronic) Electronic approach: Pelikan Technologies

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? = mechanical approaches What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? What is needed? What is the future?

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Content of presentation Why finger-pricking? Which size of blood drop do we need? Why do we prick finger tips? What induces pain? What do patients do in reality? How can we reduce the pain? = Laser Which lancing devices are the best and why? What is needed? What is the future?

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CGM without need for calibration and recalibration Combination of all SMBG steps in one device Further improvement of e.g. the shape of the needle Performance of a long-term clinical trial that demonstrates that a reduced pain associated with lancing is worth the investment to gain reimbursement Else?

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Combination of all steps involved in SMBG in one device (first attempts)